Background: Cardiovascular disease (CVD) is associated with morbidity and mortality in patients with type 2 diabetes mellitus (T2D). However, the role of serum uric acid as a risk factor for developing cardiovascular disease is controversial. This study investigated whether uric acid variability was associated with new-onset symptomatic CVD in patients with T2D, requiring percutaneous coronary intervention.

Methods: A total of 1,071 patients were enrolled in this retrospective cross-sectional study after propensity score matching. Patients with T2D and new-onset symptomatic CVD who received percutaneous coronary intervention for the first time, and with at least three consecutive 6-monthly measurements of serum uric acid were recruited from Severance Hospital between January 2015 and December 2019. Uric acid variability was measured by average successive variability (ASV) and analyzed to evaluate a possible correlation with the risk of developing CVD.

Results: The patients were divided into quartiles based on the uric acid variability. Patients in the highest quartile were older and presented lower renal function and a higher mortality from CVD. There was a linear association between a high uric acid variability and the development of CVD. Compared to the lowest quartile, patients in the higher quartiles had a higher risk of CVD [quartile 3: adjusted odds ratio (aOR) = 1.76; 95% confidence interval (CI), 1.20–2.82; P = 0.019; quartile 4 aOR = 2.89; 95% CI, 1.74–4.80; P < 0.001].

Conclusion: High uric acid variability is independently associated with an increased risk of new-onset symptomatic CVD requiring percutaneous coronary intervention in patients with T2D. Thus, maintaining serum uric acid in a narrow range by prescribing effective medications is essential to prevent new-onset CVD in patients with T2D. Nonetheless, the potential use of uric acid variability as a predictive marker of CVD in patients with T2D needs further validation.

背景：心血管疾病 (CVD) 与 2 型糖尿病 (T2D) 患者的发病率和死亡率有关。然而，血清尿酸作为发生心血管疾病的危险因素的作用是有争议的。本研究调查了需要经皮冠状动脉介入治疗的 T2D 患者中，尿酸变异性是否与新发症状性 CVD 相关。

方法：在倾向评分匹配后，共有 1,071 名患者参加了这项回顾性横断面研究。2015 年 1 月至 2019 年 12 月从 Severance 医院招募首次接受经皮冠状动脉介入治疗且至少连续 6 个月测量血清尿酸的 T2D 和新发症状性 CVD 患者。 测量尿酸变异性通过平均连续变异性 (ASV) 进行分析，以评估与发生 CVD 风险的可能相关性。

结果：根据尿酸变异性将患者分为四分位数。最高四分位数的患者年龄较大，肾功能较低，心血管疾病死亡率较高。高尿酸变异性与 CVD 的发展之间存在线性关联。与最低四分位数相比，处于较高四分位数的患者患心血管疾病的风险更高 [四分位数 3：调整后的优势比 (aOR) = 1.76；95% 置信区间 (CI)，1.20–2.82；磷= 0.019; 四分位数 aOR = 2.89；95% CI，1.74–4.80；磷 < 0.001]。

结论：高尿酸变异性与 T2D 患者需要经皮冠状动脉介入治疗的新发症状性 CVD 风险增加独立相关。因此，通过开具有效药物将血清尿酸维持在一个狭窄的范围内对于预防 T2D 患者新发 CVD 至关重要。尽管如此，将尿酸变异性用作 T2D 患者 CVD 预测标志物的潜在用途需要进一步验证。